Frailty in major oncologic surgery of upper gastrointestinal tract: How to improve postoperative outcomes.

INTRODUCTION: Certain surgical interventions, especially those involving upper GI tract remain challenging, due to high morbidity and mortality rates. The study of frailty in the surgical population has allowed the identification of those patients with a higher risk of poor postoperative outcomes. There remains a lack of evidence regarding the possibility of improving these results through a preoperative holistic management of the patients. The aim of this study is to evaluate whether preoperative treatment, in carefully selected patients, can improve the outcome following surgery. PATIENTS AND METHODS: Between March 2015 and February 2016 patients affected by malignant tumors of the upper GI tract were enrolled at our Institution for major oncologic surgery. Amongst them, frail patients (Group 1) were identified using a validated scoring system and underwent a multidisciplinary preoperative management plan, composed of nutritional intervention, physical/respiratory enhancement and optimization of ongoing therapy. Short-term postoperative outcomes were then compared with a control group (Group 2) of patients with comparable frailty features and surgical indications, who had undergone surgery in the period from March 2013 to February 2014. RESULTS: 30-days and 3-months mortality, overall and severe complication rates were found to be significantly lower (p < 0.05) in Group 1 (41 patients) when compared with Group 2 (35 patents). No significant differences were recorded for the following outcomes: length of stay, referral to post-discharge institutionalisation and hospital re-admission. DISCUSSION: This study confirms advantages provided by preoperative treatment in frail patients, suggesting a new pathway for the improvement of postoperative outcomes.

Methane sources in arctic thermokarst lake sediments on the North Slope of Alaska.

The permafrost on the North Slope of Alaska is densely populated by shallow lakes that result from thermokarst erosion. These lakes release methane (CH4 ) derived from a combination of ancient thermogenic pools and contemporary biogenic production. Despite the potential importance of CH4 as a greenhouse gas, the contribution of biogenic CH4 production in arctic thermokarst lakes in Alaska is not currently well understood. To further advance our knowledge of CH4 dynamics in these lakes, we focused our study on (i) the potential for microbial CH4 production in lake sediments, (ii) the role of sediment geochemistry in controlling biogenic CH4 production, and (iii) the temperature dependence of this process. Sediment cores were collected from one site in Siqlukaq Lake and two sites in Sukok Lake in late October to early November. Analyses of pore water geochemistry, sedimentary organic matter and lipid biomarkers, stable carbon isotopes, results from CH4 production experiments, and copy number of a methanogenic pathway-specific gene (mcrA) indicated the existence of different sources of CH4 in each of the lakes chosen for the study. Analysis of this integrated data set revealed that there is biological CH4 production in Siqlukaq at moderate levels, while the very low levels of CH4 detected in Sukok had a mixed origin, with little to no biological CH4 production. Furthermore, methanogenic archaea exhibited temperature-dependent use of in situ substrates for methanogenesis, and the amount of CH4 produced was directly related to the amount of labile organic matter in the sediments. This study constitutes an important first step in better understanding the actual contribution of biogenic CH4 from thermokarst lakes on the coastal plain of Alaska to the current CH4 budgets.

A probiotics-containing biscuit modulates the intestinal microbiota in the elderly.

OBJECTIVES: Evaluation of the impact of a biscuit containing the probiotics Bifidobacterium longum Bar33 and Lactobacillus helveticus Bar13 on the intestinal microbiota in the elderly. DESIGN: Randomized double-blind placebo-controlled trial. PARTICIPANTS: Thirty-two elderly volunteers living in Italy. The group was composed of 19 women and 13 men aged between 71 and 88 years (mean 76). INTERVENTION: Subjects were randomized in two groups consuming one dose of the probiotics-containing biscuit or placebo once a day for 30 days. MEASUREMENTS: For each subject the intestinal microbiota was characterized using the phylogenetic microarray platform HTF-Microbi.Array before and after intervention. RESULTS: Our data demonstrated that one-month consumption of a probiotics-containing biscuit was effective in redressing some of the age-related dysbioses of the intestinal microbiota. In particular, the probiotic treatment reverted the age-related increase of the opportunistic pathogens Clostridium cluster XI, Clostridium difficile, Clostridium perfringens, Enterococcus faecium and the enteropathogenic genus Campylobacter. CONCLUSION: The present study opens the way to the development of elderly-tailored probiotic-based functional foods to counteract the age-related dysbioses of the intestinal microbiota.

Effect of Coenzyme Q10 in mitigating oxidative DNA damage in Down syndrome patients, a double blind randomized controlled trial.

Down syndrome (DS) is a chromosomal abnormality (trisomy 21) associated with a complex phenotype. Oxidative stress is known to play a major role in this pathology both due to genetic and epigenetic factors, suggesting that oxidative imbalance contributes to the clinical manifestation of DS. In particular, the implications of oxidative DNA damage in Down syndrome has been linked with neurodegeneration. Here we report the results of a double blind controlled trial aimed at investigating the protective effect of Coenzyme Q(10) on DNA oxidation in this clinical setting using the single cell gel electrophoresis technique.

Coenzyme Q10 and oxidative imbalance in Down syndrome: biochemical and clinical aspects.

Down syndrome (DS) is a chromosomal abnormality (trisomy 21) associated with mental retardation and Alzheimer-like dementia, characteristic change of the individual's phenotype and premature ageing. Oxidative stress is known to play a major role in this pathology since a gene dose effect leads to elevated ratio of superoxide dismutase to catalase/glutathione peroxidase compared to controls in all age categories suggesting that oxidative imbalance contributes to the clinical manifestation of DS. Hyperuricemia is another feature of DS that has an interesting relationship with oxidative stress since uric acid represents an important free radical scavenger. However its formation is connected to the conversion of Xanthine dehydrogenase (XDH) to Xanthine oxidase (XO) which leads to concomitant production of free radicals. Here we report that plasma samples from DS patients in pediatric age, despite an increased total antioxidant capacity, largely due to elevated Uric acid content (UA), present significantly elevated markers of oxidative damage such as increased allantoin levels. Moreover DS plasma samples do not differ from healthy control ones in terms of Coenzyme Q10 and susceptibility to peroxidative stimuli. On the contrary, lymphocyte and platelet CoQ10 content was significantly lower in DS patients, a fact that might underlie oxidative imbalance at a cellular level.

Interaction of probiotic Lactobacillus and Bifidobacterium strains with human intestinal epithelial cells: adhesion properties, competition against enteropathogens and modulation of IL-8 production.

The human intestinal microbiota plays a pivotal role in human nutrition and health by promoting the supply of nutrients, preventing pathogen colonization and shaping and maintaining normal mucosal immunity. The depletion of the individual microbiota can result in a higher susceptibility to enteropathogenic bacteria infection. In order to reduce this risk, the use of food supplements containing probiotic bacteria has been recently addressed. In this paper, we investigate the protective role toward enteropathogen infection of probiotic strains belonging to Lactobacillus and Bifidobacterium. According to our experimental data, Lactobacillus acidophilus Bar13, L. plantarum Bar10, Bifidobacterium longum Bar33 and B. lactis Bar30 were effective in displacing the enteropathogens Salmonella typhimurium and Escherichia coli H10407 from a Caco-2 cell layer. Moreover, L. acidophilus Bar13 and B. longum Bar33 have been assessed for their immunomodulatory activity on IL-8 production by HT29 cells. Both strains showed the potential to protect enterocytes from an acute inflammatory response. These probiotic strains are potential candidates for the development of new functional foods helpful in counteracting enteropathogen infections.

Liquid sourdough fermentation: industrial application perspectives.

Sourdough fermentation is considered to play a key role to get improved flavour, texture, nutritional and shelf-life properties of bakery products. Since few years Barilla R&D has been focusing on liquid sourdough fermentation which may deserve several advantages with respect to traditional processes. The results showed that the micro-biota of sourdough markedly influences flavour and texture of bakery products. Particular attention has been paid to lactic acid bacteria and yeasts. Selected lactic acid bacteria and yeasts were tested in sourdough liquid fermentation as single strain or in association. The parameters of fermentations were optimized and standardized to set up a laboratory plant liquid fermentation. Only a few strains of lactic acid bacteria were found to be suitable for liquid fermentation alone or in association with yeasts. Fermentations were carried out at pilot plant and an industrial technology was developed. This work describes the results found for the organoleptic profile of an industrial bread started with liquid sourdough with respect to bakers' yeast bread without sourdough addition.

Principal component analysis of chest wall movement in selected pathologies.

A method is presented for assessing a compact set of parameters characteristic of respiratory system functional status. 3D movements of points in the chest wall and the volumes of chest wall compartments (pulmonary rib cage, abdominal rib cage and abdomen) are considered. The co-ordinates of these points are measured using an opto-electronic system for 3D motion analysis. Principal component analysis is applied to these data. The behaviour of the eigenvectors of the covariance matrix of the 3D co-ordinates of the points on the chest wall shows close agreement with the pathology characteristics. The same is found for the percentage of total variance explained by the principal components of the volume variations. In this case, the higher values of variance percentage explained indicate independent motions (active or passive) in the degrees of freedom of the system identified by partitioning the total volume into compartments.

Chest wall and lung volume estimation by optical reflectance motion analysis.

Estimation of chest wall motion by surface measurements only allows one-dimensional measurements of the chest wall. We have assessed on optical reflectance system (OR), which tracks reflective markers in three dimensions (3-D) for respiratory use. We used 86 (6-mm-diameter) hemispherical reflective markers arranged circumferentially on the chest wall in seven rows between the sternal notch and the anterior superior iliac crest in two normal standing subjects. We calculated the volume of the entire chest wall and compared inspired and expired volumes with volumes obtained by spirometry. Marker positions were recorded by four TV cameras; two were 4 m in front of and two were 4 m behind the subject. The TV signals were sampled at 100 Hz and combined with grid calibration parameters on a personal computer to obtain the 3-D coordinates of the markers. Chest wall surfaces were reconstructed by triangulation through the point data, and chest wall volume was calculated. During tidal breathing and vital capacity maneuvers and during CO2-stimulated hyperpnea, there was a very close correlation of the lung volumes (VL) estimated by spirometry [VL(SP)] and OR [VL(OR)]. Regression equations of VL(OR) (y) vs. VL(SP) (x, BTPS in liters) for the two subjects were given by y = 1.01x-0.01 (r = 0.996) and y = 0.96x + 0.03 (r = 0.997), and by y = 1.04x + 0.25 (r = 0.97) and y = 0.98x + 0.14 (r = 0.95) for the two maneuvers, respectively. We conclude spirometric volumes can be estimated very accurately and directly from chest wall surface markers, and we speculate that OR may be usefully applied to calculations of chest wall shape, regional volumes, and motion analysis.

A new method for 3D optical analysis of chest wall motion.

A method for kinematic analysis of chest wall motion is presented, based on a TV-image processor which allows a three-dimensional assessment of volume change of the trunk by automatically computing the co-ordinates of several passive markers placed on relevant landmarks of the thorax and abdomen. The parallel computation used for the image processing allows a real time recognition of the passive markers with the necessary accuracy. A geometric model also allows the on-line computation of the contribution to the chest volume by the different parts. For this purpose the model is based on 96 tetrahedrons which can be grouped into 16 compartments and into four sections representing: upper thorax (reflecting the action of neck and parasternal muscles and the effect of pleural pressure), lower thorax (reflecting the action of diaphragm and the effect of pleural and abdominal pressure), upper and lower abdomen (reflecting the actions of diaphragm and abdominal muscles). The volume can also be split into two vertical sections pointing out asymmetrics between the right and left side. The method is non-invasive, non-ionizing and leaves the subject maximum freedom of movement during the test, thus being suitable for routine clinical analysis. The monitoring of the subject can be prolonged in time and can be performed in different postures: standing, sitting, supine and lying on one side. The method was tested on eight healthy subjects showing good accuracy, reliability and reproducibility.

Three-dimensional optical analysis of chest wall motion.

A method for kinematic analysis of chest wall motion is presented, based on a television-image processor that allows a three-dimensional assessment of volume change of the trunk by automatically computing the coordinates of several passive markers placed on relevant landmarks of the thorax and abdomen. The parallel computation used for the image processing allows for a real time recognition of the passive markers with the necessary accuracy. A geometric model also allows the online computation of the contribution to the chest volume by the different parts. For this purpose, the model presented here is based on 54 tetrahedrons that can be grouped into 9 compartments and 3 sections representing 1) upper thorax (mainly reflecting the action of neck and parasternal muscles and the effect of pleural pressure), 2) lower thorax (mainly reflecting the action of diaphragm and the effect of pleural and abdominal pressure), and 3) abdomen (mainly reflecting the actions of diaphragm and abdominal muscles). By this model, the volume can also be split into three vertical sections pointing out asymmetries between the right and left sides. The method is noninvasive, nonionizing, and leaves the subject maximum freedom of movement during the test, thus being suitable for routine clinical analysis. The monitoring of the subject can be prolonged in time and can be performed in different postures: standing, sitting, and supine. The method was tested on 12 healthy subjects showing its good accuracy, reliability, and reproducibility.

Remarks and experiments on the construction of respiratory waveforms from electrocardiographic tracings.

We report on some observations and preliminary experiments on the deduction of respiratory waveforms from electrocardiographic traces by interpolating the values of angles related to a cardiac electrical axis. The experiments concern comparing the trends obtained from different definitions of the cardiac electrical axis: respiratory waveforms deducted by considering the electrical axis of either the QRS complex or the T wave, and those deducted in the presence of cardiac rhythm disorders, noise, and drifts. The most significant result was obtained when, starting from an ECG trace, we were able to plot curves that were very close to the respiration curve obtained from a belt impedance meter. This result indicates that the objective can be attained. Other results concern specific cases and the constraints to be observed. Among those, arrhythmia, missing beats, pauses, noise, and drifts superimposed on the original ECG traces.

[Electrophoretic and immunological characteristics of non-histone proteins of human skin tumors. II) Results]. / Caratteristiche elettroforetiche ed immunologiche delle proteine non-istoniche dei tumori cutanei umani. - II) Risultati.

In this communication we present the immunoelectrophoretic profiles of non-histone proteins of the cellular nucleus of some types of human skin tumours. The results show that the nuclear non-histone proteins of different types of tumours are quantitatively different from one another. The immunoelectrophoretic profiles of the samples show that an antigenic affinity between the skin tumours concerns most of the nuclear proteins of each sample.